Introduction
Irreversible prerenal acute kidney injury (AKI) characterized by patchy/diffuse ischemic destruction of the renal cortex.
- RCN accounts for 6-7% of all causes of acute kidney injury (AKI)
Aetiology
Obstetrical cause (50–70% cases):
- Septic abortion
- Puerperal sepsis
- Abruptio placentae
- Eclampsia
- Obstetric haemorrhage
- Intrauterine death (IUD)
- Thrombotic microangiopathy of pregnancy (P-TMA)
Non-obstetrical causes (20-30% cases. ♂>♀):
- Extensive burns, sepsis, HUS, pancreatitis, snake bite, and diabetic ketoacidosis
Pathophysiology
- Significantly diminished arterial perfusion of the kidneys due to spasms of the feeding arteries, microvascular injury, or disseminated intravascular coagulation (DIC).
- Pathological progression of acute tubular necrosis (ATN)
Clinical features
Clinical course:
- Death in uraemia during acute phase
- Survival without dialysis
- Late return to dialysis/transplant
- Survival only with chronic maintenance dialysis/transplant
- Late resumption of sufficient renal function to become dialysis independent
Complications
Causes of death during acute phase:
- Severe uraemia
- Sepsis
- Pulmonary oedema
- Gastrointestinal haemorrhage
- Hyperkalemia
- Multiorgan failure
